ASSOCIATION OF LEFT VENTRICULAR HYPERTROPHY AND GEOMETRY TO ASYMPTOMATIC CEREBROVASCULAR DAMAGE IN ESSENTIAL HYPERTENSION

Objectives:

The level of arterial pressure is one of the most important determinants of cardiac adaptation to hypertension and also one of the most important predictors of cardiovascular and cerebrovascular morbidity, including strokes. Multiple studies were performed on the association between left ventricular hypertrophy and preclinical brain damage in essential hypertensive patients.

Methods:

In order to identify the relation between hypertension level, duration, age, sex and left ventricular geometry to asymptomatic brain damage, we categorized 50 essential hypertensive patients (M/20-%40; F/30-60%) using M-mode echocardiography. All the patients had been admitted in the cardiac emergency room for hypertension control According to the value of end diastolic relative wall thickness (RWT) and left ventricular mass index (LVMI), the patients were categorized into four groups: 5 patients had normal LVMI and normal RWT (normal geometry) (group 1); 7 patients had increased (RWT) and normal LVMI (concentric remodeling) (group 2); 12 patients had increased LVMI and normal RWT (eccentric hypertrophy) (group3); and 26 patients had increased LVMI and RWT (concentric hypertrophy) (group 4). Afterwards, brain MRI was performed, followed by an evaluation of lacunar lesions and leukoaraiosis in the four groups.

Results:

The severity of leukoaraiosis was significantly greater in patients with concentric hypertrophy than in patients with normal left ventricular geometry (Chi-square 24.5, P=0.002). The number of lacunae was also significantly higher in patients with concentric left ventricular hypertrophy than in patients with normal left ventricular, geometry.(Chi -Square 17.25 P=0.000).

Conclusion:

Stepwise regression analysis confirmed that LVMI and RWT in addition to age and sytolic blood pressure were independent predictors for asymptomatic cerebrovascular damage.